第 二 篇 經 營 成 效 與 品 質 提 升
Chapter 2 Achievements &Quality Assurance Initiatives
71
醫療給付改善方案
全民健保醫療給付改善方案，係透過
調整支付醫療院所醫療費用的方式，提供
適當誘因，引導醫療服務提供者朝向提供
整體性醫療照護發展，並以醫療品質及效
果作為支付費用的依據。自
2001
年
10
月
起，分階段實施子宮頸癌、乳癌、結核病、
糖尿病及氣喘等
5
項醫療給付改善方案。
除子宮頸癌方案自
2006
年起業務移由國民
健康署辦理外，該年亦同時於西醫基層診
所試辦高血壓醫療給付改善方案，
2007
年
更擴及醫院執行。另結核病醫療給付改善
方案，自
2008
年起，導入支付標準全面實
施辦理。近年各方案之照護率如表
13
。
2010
年
1
月 新 增 精 神 分 裂 症、 慢
性
B
型肝炎帶原者與
C
型肝炎感染者等
2
項論質方案，
2011
年
1
月再新增初期
慢性腎臟病論質方案。糖尿病方案因執
行成效良好，於
2012
年
10
月導入支付
標準全面實施；高血壓方案收案對象常
合併有糖尿病、慢性腎臟病等疾病，為
整併照護方式，自
2013
年起不再列為
單獨項目，而併入其他論質方案推行。
Reimbursement Plans
that Improve Health Care Quality
The NHIA has developed a series of plans that are
structured to improve the quality of care while keeping costs
under control. The plans offer health care providers incentives
to care for patients’ overall well-being by reimbursing them
based on clinical outcomes. The NHIA phased in this pay-
for-performance system in phases beginning in October 2001
to cover payment for the treatment of cervical cancer, breast
cancer, tuberculosis, diabetes and asthma based on well-
defined clinical criteria. Themanagement of the cervical cancer
program was handed over to the Bureau of Health Promotion
at the start of 2006, but that same year hypertension treated at
western medicine clinics was added to the ailments included
under this pay-for-performance structure. In 2007, hospitals
became eligible to treat hypertension under the plan, and in
2008,
the pay-for-performance tuberculosis plan became
the standard for treatment of the disease. The percentage of
patients being treated under outcome-based plans in recent
years is shown inTable 13.
Two more pay-for-performance plans were added in
January 2010 for schizophrenia and for hepatitis B carriers and
hepatitis C patients, and another was introduced in January
2011
for early chronic kidney disease. Because of the positive
impact of the pay-for-performance plan in treating diabetes, it
was instituted as the standard for all diabetes cases in October
2012.
Hypertension sufferers on outcome-based plans were
often found to suffer from other comorbidities such as diabetes
and chronic kidney disease, and to better integrate care, the
outcome-based program for the treatment of hypertension was
incorporated into the pay-for-performance plans for these other
illnesses beginning in 2013.